Adult Blood Lead Epidemiology and Surveillance -- United States,
1994 and First Quarter 1995

CDC's National Institute for Occupational Safety and Health
(NIOSH) Adult Blood Lead Epidemiology and Surveillance program
(ABLES) monitors elevated blood lead levels (BLLs) among adults in
the United States (1). Twenty-three states currently report
surveillance results to ABLES. Maine is the 23rd state, and its
data (beginning in 1994) are included for the first time in this
report. This report presents ABLES data for the first quarter of
1995 compared with the first quarter of 1994 and annual data for
1994 compared with 1993.

First Quarter Reports 1995. During January-March 1995, the
number of reports of elevated BLLs increased by 10% over those
reported for the same period in 1994 Table_1. The number of
reports increased at the lowest reporting level (25-39 ug/dL), but
decreased at all higher reporting levels (40-49 ug/dL, 50-59 ug/dL,
and greater than or equal to 60 ug/dL). The trend of increasing
reports at the lower levels and decreasing reports at the higher
levels is consistent with the 1994 fourth quarter report (2).

Annual Reports 1994. The reported number of adults with
elevated BLLs increased from 11,240 in 1993 to 12,137 in 1994
Table_2; this increase resulted, in part, from the addition of
three reporting states in 1994. A total of 5619 new cases accounted
for 46% of the cases reported in 1994, compared with 59% new cases
in 1993 Table_2. Compared with 1993, the proportion of new
cases
declined in the 25-39 ug/dL, 40-49 ug/dL, and 50-59 ug/dL
categories and increased in the greater than or equal to 60 ug/dL
category. Even with additional states reporting, the number of new
cases decreased 15% from 1993 through 1994 Table_2. This
decrease
may be explained in part by the definition of a new case, which is
an elevated BLL ( greater than or equal to 25 ug/dL) in an adult
reported in state surveillance data in the current year but which
was not recorded in the immediately preceding year. By this
definition, all persons reported represent new cases in the year a
state begins surveillance.
Reported by: JP Lofgren, MD, Alabama Dept of Public Health. C
Fowler, MS, Arizona Dept of Health Svcs. S Payne, MA, Occupational
Lead Poisoning Prevention Program, California Dept of Health Svcs.
BC Jung, MPH, Connecticut Dept of Public Health and Addiction Svcs.
M Lehnherr, Occupational Disease Registry, Div of Epidemiologic
Studies, Illinois Dept of Public Health. R Gergely, Iowa Dept of
Public Health. B Carvette, MPH, Occupational Health Program, Bur of
Health, Maine Dept of Human Svcs. E Keyvan-Larijani, MD, Lead
Poisoning Prevention Program, Maryland Dept of the Environment. R
Rabin, MSPH, Div of Occupational Hygiene, Massachusetts Dept of
Labor and Industries. M Scoblic, MN, Michigan Dept of Public
Health. L Thistle-Elliott, MEd, Div of Public Health Svcs, New
Hampshire State Dept of Health and Human Svcs. B Gerwel, MD,
Occupational Disease Prevention Project, New Jersey State Dept of
Health. R Stone, PhD, New York State Dept of Health. S Randolph,
MSN, North Carolina Dept of Environment, Health, and Natural
Resources. E Rhoades, MD, Oklahoma State Dept Health. A Sandoval,
MS, State Health Div, Oregon Dept of Human Resources. J Gostin, MS,
Occupational Health Program, Div of Environmental Health,
Pennsylvania Dept of Health. R Marino, MD, Div of Health Hazard
Evaluations, South Carolina Dept of Health and Environmental
Control. D Perrotta, PhD, Bur of Epidemiology, Texas Dept of
Health. D Beaudoin, MD, Bur of Epidemiology, Utah Dept of Health.
L Toof, Div of Epidemiology and Health Promotion, Vermont Dept of
Health. J Kaufman, MD, Washington State Dept of Labor and
Industries. V Ingram-Stewart, MPH, Wisconsin Dept of Health and
Social Svcs. Div of Surveillance, Hazard Evaluations, and Field
Studies, National Institute for Occupational Safety and Health,
CDC.

Editorial Note

Editorial Note: Approximately 54% of the persons reported to ABLES
in 1993 were reported again to the system in 1994. Reasons for
these repeat reports include 1) recurring exposure resulting from
inadequate control measures and worker-protection practices; 2)
routine tracking of elevated employee BLLs that remain below levels
requiring medical removal; and 3) increased employer monitoring
during medical removal. Increased testing of workers in
construction trades -- as new workplace medical monitoring programs
are established to comply with new OSHA regulations (3) -- also has
contributed to the increases.

Reporting of adults with elevated BLLs reflects monitoring
practices by employers. Variation in national quarterly reporting
totals, especially first quarter totals, may result from 1) changes
in the number of participating states, 2) timing of receipt of
laboratory BLL reports by state-based surveillance programs, and 3)
interstate differences in worker BLL testing by lead-using
industries.

The data in this report underscore that work-related lead
exposures are an ongoing occupational health problem in the United
States. ABLES can further enhance surveillance for this preventable
condition by expanding the number of participating states, reducing
variability in reporting, and distinguishing between new and
recurring elevated BLLs in adults. The Council of State and
Territorial Epidemiologists, at its annual meeting in May 1995,
designated elevated BLLs among adults as a condition reportable to
the National Public Health Surveillance System (formerly the
National Notifiable Diseases Surveillance System) (4).

Table_1Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Number of reports of elevated blood lead levels (BLLs) among adults,
number of adults with elevated BLLs, and percentage change in number of reports
-- 23 states, * first quarter, 1994-1995
=====================================================================================
First quarter, 1995 No. Reports, % change
Reported BLL --------------------------- first quarter, first quarter,
(ug/dL) No. reports No. persons & 1994 + 1994 to 1995
-------------------------------------------------------------------------------------
25-39 4914 3635 4102 +20%
40-49 1197 878 1371 -13%
50-59 245 204 278 -12%
>=60 82 58 117 -30%
Total 6438 4775 5868 +10%
-------------------------------------------------------------------------------------
* Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maine, Maryland,
Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina,
Oklahoma, Oregon, Pennsylvania, South Carolina, Texas, Utah, Vermont, Washington,
and Wisconsin.
+ Data for Maine are included. These data only recently became available for 1994
and were not included in previous reports.
& Individual reports for persons are categorized according to the highest reported
BLL for the person during the given quarter. Pennsylvania provides the number of
reports but not number of persons; the number of persons for Pennsylvania in this
table are estimates based on the proportions from the other 22 states combined and
the number of reports received from Pennsylvania. Data for South Carolina were
missing; first quarter 1994 data were used as an estimate.
=====================================================================================

Table_2Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 2. Number of reports of elevated blood lead levels (BLLs) among adults,
number of adults with elevated BLLs, and new cases of elevated BLLs
-- United States, 1993 and 1994
==================================================================================
1994 (23 states) * 1993 (20 states) +
------------------------------- ------------------------------------
New cases @ New cases **
Reported BLL No. No. ----------- No. No. -----------------
(ug/dL) reports persons & No. (%) reports persons No. (%)
----------------------------------------------------------------------------------
25-39 19,420 8,651 4,254 (49) 18,529 8,041 4,693 (58)
40-49 5,821 2,562 887 (35) 5,398 2,293 1,288 (56)
50-59 1,132 644 269 (42) 1,311 627 419 (67)
>=60 & 459 280 209 (75) 633 279 184 (66)
Total 26,832 12,137 5,619 (46) 25,871 11,240 6,584 (59)
----------------------------------------------------------------------------------
* Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maine, Maryland,
Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina,
Oklahoma, Oregon, Pennsylvania, South Carolina, Texas, Utah, Vermont,
Washington, and Wisconsin. Data for Maine were not included in previous
reports. Data for South Carolina were missing for fourth quarter 1994; fourth
quarter 1993 data were used as an estimate.
+ Same states as 1994 except for Maine, North Carolina, and Oklahoma.
& Individual reports are categorized according to the highest reported BLL for
the person during the given year. Pennsylvania provides the number of reports
but not number of persons; the number of persons for Pennsylvania in this
table are estimates based on the proportions from the other 22 states combined
and the number of reports received from Pennsylvania. Data for South Carolina
were missing for the fourth quarter 1994; fourth quarter 1993 data were used
as an estimate.
@ Illinois, Michigan, Pennsylvania and South Carolina did not report new cases
for 1994. New cases for those four states are estimates based on the
proportions from the other 19 states combined and the number of reports,
persons, or unassigned new cases reported from these four states.
** New cases for 1993 were not reported from Michigan, New Hampshire, and
Pennsylvania. No estimates are included in the 1993 data.
==================================================================================

DisclaimerAll MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.